File SECLUSION_RESTRAINT(615.2) Data List
| FILE ENTRY DATE |
NAME |
DATE/TIME APPLIED |
WARD |
NAME OF NURSE PRESENT |
NURSING SHIFT |
PATIENT SEARCHED |
SEARCH COMMENT |
REASONS FOR S/R |
MEDICATIONS |
BEHAVIOR REQUIRED FOR RELEASE |
ORDERED BY |
ORDER TYPE |
DATE/TIME OF ORDER |
DATE ORDER CHANGED |
GENERAL COMMENTS |
INITIAL TRANSCRIBER |
RELEASE ORDERED BY |
PERSONNEL EFFECTING RELEASE |
TIME REMOVED |
RELEASE TRANSCRIBER |
RELEASE FILED |
CIRCUMSTANCES/FURTHER ACTIONS |
TYPE OF SECLUSION/RESTRAINT |
REVIEWED BY |
ACTION |
ACTUAL DATE OF REVIEW |
REVIEW TRANSCRIBER |
REVIEW FILED |
REVIEWER'S COMMENTS |
ATTEMPTED ALTERNATIVES |
OBSERVATION CHECK TIME |
DIAGNOSIS |
LAST4 SSN |